Short or long IVF protocol to improve... - Fertility Network UK

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Short or long IVF protocol to improve egg quality? Advice needed...

MissZJB
MissZJB

Hey! I hope everyone is well and coping in these strange times.

I have just had a virtual review appointment with my consultant and have been left pondering which protocol to try for my next IVF cycle. I am really unsure what to do and the consultant is awaiting my decision before a treatment plan can be put together and treatment scheduled.

The background...

14 years ago I had long protocol on the NHS using Menopur. This was cancelled due to a poor response. I then tried again with the maximum dose and 8 eggs were collected - BFN.

Last May I had short protocol using Gonal F - 9 eggs collected - day 2 transfer - BFN nothing to freeze.

Last Aug, another round with short protocol and Gonal F, additional supplements and improved diet - 15 eggs collected - BFN nothing to freeze.

So now my consultant is wondering whether we should try the long protocol with the Gonal F but has of course left it to us to make the decision as there are no guarantees this will improve the outcome.

The problem appears to be egg quality. The numbers are okay and fertilisation rate is good but them things go downhill from there.

I really don't know what to do. This is likely to be our last attempt and I just want to make the right decision, trouble is I don't know what that is!

If anyone is able to offer any advice I would be very grateful, I feel in a real muddle and don't know where else to turn.

Thank you all in advance

Zoe x

36 Replies
oldestnewest

Hi 🙂 I am absolutely no expert but from reading your post I’d say it looks like the long protocol has been the one with most success in the past (albeit 14 years ago) so I think I’d probably go with that. Sorry I can’t be of more use just thought I’d reply with my initial thoughts!! Hope it all goes well for you whatever you choose Xx

MissZJB
MissZJB in reply to Beanybeanz

I’m thinking long protocol but with gonal f this time.

Thank you for your reply x

I think this is so difficult to make this decision. I would have liked more of an input from the consultant as to what they would suggest too. I cant offer any advice, but after 2 failed cycles on short protocol, I am currently do long protocol for our 3rd. We changed clinics and he said we prefer to do long protocol, and would like to think it would help with egg quality. Really hope this is the case. Sometimes those with lower amh get put on long protocol, but then I've seen stories of the complete opposite. I would be interested to see what the other ladies think. Best of luck to you whatever you decide, really hope this is your time xxx

MissZJB
MissZJB in reply to Italy300618

Sounds like we are in a similar position. The clinic give all the options but won’t advise which way to go. I just want someone to tell me what to do! It’s so hard. How are you getting on with the long protocol this time? Sending you the best of luck and hope this is the time for us both x

Italy300618
Italy300618 in reply to MissZJB

I would be exactly the same, just someone tell me what to do! I think if your most recent times have been with short protocol it may be worth giving long protocol another try?

Its going ok thank you, hormones are a bit of a nightmare but oh well, thank you very much xx

Hiya MissZJB

I did my first cycle under a short protocal 9 eggs retrieved 9 fertilised 2 put back in but BFN in feb.

I'm now on long protocal as this ones slows the process down but more 💉

I defintly feel more relaxed on this one its a differcult one all I'd say is go with your gut. Good Luck xx

MissZJB
MissZJB in reply to Jaten

Thank you so much for your reply, it’s nice to hear you feel more relaxed - I could definitely do with that! I don’t mind the extra injections i just wish I knew what to do for the best. Best of luck to you x

What a tough decision to make. I really feel for you!

I think long or short being better is different for everyone. The fact that you’ve tried a few times on short and had early transfers with nothing to freeze, switching to long seems like a sensible next step. I had a similar story but with the other way round, 3 long protocol cycles with 2 day transfers and nothing to freeze. For our fourth, we switched clinics and they recommended doing a short protocol and we ended up with 3 perfect 5 day blasts so it was a massive game changer for us.

All our bodies are different and respond better to different approaches. Changing what isn’t working for you is a positive step xx

MissZJB
MissZJB in reply to KiboXX

It’s so hard. If changing worked for you, who knows it could work for me too 🤞🤞🤞

KiboXX
KiboXX in reply to MissZJB

Exactly! All you can go on right now is the short protocol isn’t working for you so it can’t hurt to try a different approach.

One other thing we added to our 3&4 cycles was a double trigger shot which is supposed to give your eggs a final boost. Those were the only cycles we got to day 5 so worth asking for if you haven’t already done this xx

MissZJB
MissZJB in reply to KiboXX

I had a double trigger with the last attempt and we did get to day 5 but the quality was poor. Still better though so we will be having a double trigger again. I just need to work out how to improve quality now - it’s one thing after another isn’t it. I feel like I try everything each time and then I read about something else!

KiboXX
KiboXX in reply to MissZJB

Honestly I could have written that! We did the double trigger on our 3rd round, still on long protocol and we did make it to day 5 but bfn and nothing left to freeze. Cycles 1&2 we had a day 2 transfer.

We kept the double trigger in when we switched to short for our 4th cycle. I honestly tried all the fads to improve my eggs but the only things that’s made a noticeable difference were the double trigger and switching protocols xx

I have been just through 4 rounds of IVF. With my last round - I did plasma rejuvenation (they inject plasma in to your ovaries) and took DHEA religiously - I finally got two good quality embryos DAY 5. I am trying not to get my hopes but was finally happy to get two embryos. I have Low Ovarian Reserve. BEST OF LUCK.

I would research the DHEA.

Loulaaa
Loulaaa in reply to Lind58

Hi Linda ,

Would you mind providing me more details about ovarien rejuvenation in PM please ?

Thanks Xoxo

I don't have any advice but just wanted to say that whichever decision you make you can't possibly know if it's the right one. If it doesn't work it won't necessarily be the fault of the medication so although it's impossible not to overthink it go with the decision that gives you the most peace and don't blame your decision at this point if things don't work. I think the fact that the clinic have given you the right to a decision shows that they don't know any better which way will be more likely to work so just do what you feel is best. I really hope it works for you.

MissZJB
MissZJB in reply to runuphill

That’s great advice and you are totally right. Thank you so much x

Hi

I did two cycles of short protocol last year - egg quality was awful - out of a total

Of 28 eggs less than 30% fertilised and I ended up with 4 average quality blastocysts

We then decided to go further and reduced to natural modified IVF - barely any drugs. Over 3 cycles I got a total of 9 eggs - 100% fertilised and 4 top quality blastocysts- I’m currently 5 weeks pregnant having remastered 2 blastocysts

I’m a big supporter of less is more when it comes to egg quality unless you are in your 20s and are doing IVF due to male factor

Loulaaa
Loulaaa in reply to Ivfgotadream

Hello ,

Would you mind share details of your clinic in PM please ? Thanks xx

Ivfgotadream
Ivfgotadream in reply to Loulaaa

Hi I’m with Create x

6pcda17
6pcda17 in reply to Ivfgotadream

Hi. Sorry to jump on this. If you don’t mind me asking, how old are you? I’m 38 and have just finished my first round of MILD IVF at the same clinic. 8 eggs collected, 3 fertilised, one transferred at day 3 and the other two disintegrated at day 5. I was reading about the natural modified cycle but the dr didn’t recommend it to me despite their site saying that egg quality is usually better.

Ivfgotadream
Ivfgotadream in reply to 6pcda17

I’m 37 - are you with Create?

I had a long talk with my Dr after my second failed mild IVF - I didn’t feel ready to stop but at the same time said no point wasting money doing the same protocol again as it obviously doesn’t work for me. I also did PGS on the second round and the results weren’t great - 1 complex abnormal and 1 mosaic which we were allowed to transfer. I was actually leaning towards doing fully natural IVF so no drugs at all but he recommended just a little push with natural modified. My argument was that I got pregnant on my own more times than I have with IVF (5 miscarriages) so I wanted to just at least see the difference letting my body make more of a choice would have? He was fully supportive but he did say we’d need 3 cycles to have the best odds of getting something to transfer which is why I signed up to the package.

I suppose what also helped was that my friend and I cycled exactly the same dates - she was on natural modified and I was on mild - she got twice as many blastocysts all AA grade and that’s without ICSI! I know you can’t compare two different people but I just felt it was worth a try and then we were stopping for good and I’d have no regrets that there was something different we could have tried but didn’t

He did say natural modified is more for people who don’t ovulate on their own or very infrequently but he said no harm in seeing what would happen! And you know what 2 of the 3 cycles were pure natural modified and I got top quality blastocysts- the 3rd one was more like my mild protocol as tamoxifen makes my lining too thick for transfer and quality was back to awful!

6pcda17
6pcda17 in reply to Ivfgotadream

Hi. Yes I’m with create. I spoke to the doctor, or nurse or consultant last week and she said to do exactly the same protocol again. I had the same argument that if it didn’t work, then they are the experts and should be telling me what they think they could tweak to give me a better chance of success. I understand that sometimes it simply does not work and that’s life and Mother Nature, but I guess you still want to see one thing change if you go through another cycle.

I’m tempted to do a 3 cycle package with them, I just don’t know what treatment and I’m not really being guided by the clinic either.

I’m also using donor sperm (single mother by choice... Well I hope to be), so that really Ramps up the cost unfortunately) so I really need to make the right decision.

I too have fallen pregnant naturally, only 18 months ago so I know I don’t have fertility issues. The donor sperm from the bank I used this time around has fathered two children of his own so there are no known issues there either. Everything on paper was text book, I just really wish I’d had something in the freezer as a back up.. The clinic keep on blaming it on my age which is hard to hear because that’s the only thing I can’t change.

I often wonder if I switch to a consultant led clinic where you see the same person every time, it would be better.

It’s all such conflicting advice.

My monthly cycles are as regular as clockwork, and I ovulate bang in time every month, that’s why I’m wondering if natural might be better for me. Maybe they can mix and match the package slightly, at the end of the day the procedure is the same really it’s just down to how many injection pens you buy.

Did you use Bemfola?

Thanks for getting back to my previous message xxx

Ivfgotadream
Ivfgotadream in reply to 6pcda17

It’s difficult when you’ve only had 1 cycle so far - they were more supportive with me I think because I’d had 2 cycles already?

Which Create are you at? Mine is Birmingham - I don’t always see the same consultant for scans etc but certainly for a review of the cycle/next steps it’s always been with the same one?

All Creates are consultant led its ABC which is nurse led which is why they are so much cheaper?

It’s a difficult decision because you don’t want to spend a whack more money on mild only to get the same result?

Yes I was on Bemfola - on the mild cycles it was 225ml and then natural modified was 150ml or sometimes 75ml if they mixed it with luveris x

6pcda17
6pcda17 in reply to Ivfgotadream

That could be the case. I guess I’m a relative newbie to this whole process still, and they’re learning about me as much as I’m learning about them and what they can offer etc.

I’m at the London create clinic. It’s cinvenient to where I work (well it was before lockdown and working from home started).

I think I’ll give them another call tomorrow and try and get some sort of protocol agreed and get the ball rolling etc. I don’t really want to leave it much longer.

Thank you for your help. And best of luck with everything. Xxx

Hello ,

I think you should also consider which medication to use . I read that Menupor gives better quality but less egg than Gonal -f

Although I did 2 cycle : 1 long and 1 short . First one was mainly Gonal-f and small dose of Menupor ( 1 egg not good ) . Second cycle was short and only with Menupor ( still 1 egg but better blast quality)

I also believe every body is different on how to react to medication . Go with your gut and good luck Xx

I often think the first round is always a bit hit and miss as your body is sort of working out what to do

As someone else mentioned I am often told that long protocol is better for older women or those with lower egg quality so I reckon it’s definitely worth a go again - I also think mentally you will feel better trying something different

Really hope it’s the thing to get your bfp xx

Hi, I think you should take some time and improve tour egg quality with supplement and there may be a difference at the end of it. I did mild ivf with 7 days of stims got 9 matured eggs, 6 fertilized, transfered 2 on day 3 and ended up with 3 good quality blastocyst. I am currently pregnant, had my beta yesterday and it was 247.If you read the book it starts with the egg you will understand all this. I wish you all the best in your decision making. xx

I have got that book and read it cover to cover A several times! I am trying to implement everything I can and am taking all the supplements recommended. I started in January ready for April which was then cancelled due to COVID. Unfortunately lockdown got the better of me and the wine found it’s way back in the shopping trolley! It’s looking like sept/oct now so hopefully time to make things right x

Alright that's great. By Gods grace you will get to where you want to be. I'm really sorry for the delay, I know how hard it can be, like mine too was delayed from march to this June becos of covid. The most important thing is getting the result we seek at the end of the day. Fingers crossed for you that you will return with good news. xx

I’m not an expert but from reading your post seems like the Long Protocol has had higher success rate.

I would pray on it and go with your gut feeling!!!

Wishing you all the best, and praying that your next post will be about the success!!!

Sending you baby dust!!!

MissZJB
MissZJB in reply to Soliditi

Thank you so much x

I’ve done 5 rounds of IVF in 18 months and I can honestly say supplements/ losing weight / diet / low stress / healthy lifestyle / starts with an egg suggestions had ZERO effect on my egg quality

The ONLY thing which made a difference was changing to natural modified IVF and focusing on fewer follicles. My doctor explained that there is no point in forcing your body to go the speed of Ferrari if it’s more like a Ford c max!

I honestly think that you need a specific mix of drugs to match your specific level of hormones for that specific month - there is no one size fits all. What might work one month probably won’t work the next if you aren’t in your 20s and Not at peak fertility. That’s why clinics like ARGC who who daily blood tests/scans get such good results because it’s tailored specifically to you (they are bloody expensive though!)

I’m currently pregnant with 2 blastocysts collected just after Xmas after weeks of bad eating and drinking loads. Compared to my last egg collection earlier this month where did everything “right” for months and egg quality was appalling

Also my clinic doesn’t believe long protocol is good for quality at all - most clinics prefer it because they are more in control and it’s more likely that follicles will grow at the same rate

The body just isn’t designed - even more so in mid to late 30s and older - to create that many follicles in one month which is why the majority of people on long protocol don’t get any more blastocysts to transfer at the end of it than people on short protocol or natural modified

MissZJB
MissZJB in reply to Ivfgotadream

This all makes total sense. My clinic doesn’t offer natural modified IVF and where we live really limits our options but I would be keen to find out more about this.. number of appointments, scans etc. would you be able to shed some light on this and where this is offered? Huge congratulations to you x

Ivfgotadream
Ivfgotadream in reply to MissZJB

Thanks! I’m with Create....they are the only clinic I know who really advocates natural

Modified.

In its purest form you take tamoxifen tablets (similar effect to clomid) from cycle day 3 and I did 150ml Bemfola every OTHER day and then a couple of cetrotide as needed. Egg collection around cycle day 12/13 so whole thing over in 10 days or less. That cycle I got 2 follicles both top quality day 5 and am currently pregnant with one/both of these

Second cycle I reduced bemfola to 75ml but did it daily and added 75ml Luveris from cycle day 3. Also have 2 top quality blastocysts frozen from that cycle

3rd cycle because my lining tends to get thick on tamoxifen and it was time to do a transfer my clinic said not to take it and I did daily 150ml Bemfola so more like short protocol again and guess what egg quality back to crap and got no blastocysts

Scan wise - first scan cycle day 5 (depending on how weekend fell) and then every other day until trigger shot

Cost wise 3 cycles of natural modified including ICSI, embryoscope, blood tests and scans and ALL drugs was £13k and this included freezing and storage for 2-4 cycles of egg collection and a transfer of either fresh or frozen depending on quality after the 3rd collection

I have had both...2016/2017 I had long protocol three times...was more injections over 1.5 months buserelin gonal f, ovitrelle, progynova cyclogest pessaries ... more eggs 14...12 fertilised...5 blastocysts...but all BFN....2020 had short protocol different drugs meriofert cetrotide and ovitrelle cyclogest pess, stim injections 10 days only...9 eggs 6 fertilised 3 blastocysts...transferred one fresh and 22 weeks pregnant.

2nd time round I followed it starts with the egg...more supplements time off work acupuncture and hubby took supplements and lost weight both ate healthier. I think looking at your history I would go with long protocol but if you can have some time off as well...best of luck whatever you choose...really hope it's your time xxx

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